Cataract Surgery and Dry Eye

Abstract

This chapter outlines preoperative, intraoperative, and postoperative considerations with respect to dry eye (DE) and its impact on cataract surgery, to guide optimization of patient satisfaction with their refractive outcomes. A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, PubMed, and Scopus, from the date of inception (1946) until 3rd June 2023, were searched. Dry eye and ametropia are among the most common causes of dissatisfaction after cataract surgery and also the most amenable to successful conservative management. Dry eye can reduce contrast sensitivity and increase dysphotopsias in multifocal intraocular lens patients. Several pathophysiological changes occur during and after surgery that influence DE manifestation postoperatively. Dry eye symptoms and signs generally normalize at around 3 months in both normal and DE patients, but a significant minority have ongoing discomfort. A number of systemic and ocular conditions are identified, which may aid in preoperative risk evaluation. Preoperative symptom evaluation, examination, and investigation techniques are also summarized and their influence on refractive outcomes emphasized. Current preoperative, intraoperative, and postoperative measures to decrease burden are additionally evaluated.